CASE STUDY

SCHIZOPHRENIA

A.INTRODUCTION

Schizophrenia is a chronic and severe mental disorder that affects how a

person thinks, feels, and behaves. People with schizophrenia may seem like
they have lost touch with reality. Although schizophrenia is not as common
as other mental disorders, the symptoms can be very disabling.

B.HISTORY COLLECTION

IDENTIFICATION INFORMATION

- Patient Name : KAJUJU Patrick

- Gender: male
- Address : MVKProvince/Gasabo District
- occupation : none
- Education: Secondary school
- Marital status : single
- Religion:Adventiste
- Medical diagnosis: Schizophrenia
- Date of admission : 5/7/2018

CHIEF COMPLAINTS

My bclient complaints are:Hallucinations,Delusions,Thought disorders

(unusual or dysfunctional ways of thinking),Movement disorders (agitated
body movements)

PRESENT HISTORY

The patient is having agitation,thought disorder and delusions.

PAST HISTORY

Past medical history

No history of chronic illness like diabetes, cancer, hypertension
and others
Past surgical history
No surgical history.

FAMILY HISTORY
 The patient is coming from the family of 5 persons: he has Father, 2
sisters and 2 brothers. They are no chronic diseases in the family
Family tree

This client is the lastborn of the family and is having only mother as parent.

LIFESTYLEHISTORY

He has history of drinking alcohol, using tobacco or drug abuse.

SOCIO ECONOMICHISTORY

This single client coming from the family of 7 persons. They have their own
house with one toilet outside. They have also medical insurance.

ALLERGIC HISTORY

Noknown allergic reaction either to medication, dust,food,or animal hair.

PHYSICAL EXAMINATION

Vital signs

SNO PARAMETER BOOK PICTURE (normal PATIENT REMARKS

ranges ) PICTURE
TEMPERATURE (‘c/) 36.5- 37.5oc 37oc normal
PULSE RATE (/MIN) 60-100beats/min 86beats/min normal
RESPIRATION 12-20movement/min 20movement/min normal
RATE /MIN
BLOOD PRESSURE Systolic 140-90mmhg 120/90mmhg Normal
mmHg Diastolic 90-60mmhg

 General appearance of the patient: weak

 Level of consciousness: is oriented to time place and people Gsc scale15/15
 Head : size and shape are normal
Hair
- Color: normal
- Texture: normal
- Distribution: well distributed
- Ring worms: no ring worms
- Lice : no lice
- Dandruff: no dandruff
- Scalp: no wound ,lesion or scars
 Face
 Size: normal
 Shape :long
 Edema : absent
 Skin color : dark
 No Lesions
 Scars: absent
Eye
 Is Symmetry
 No Eyelid presence edema /sunken
 Eyelashes; presence distribution is normal
 No Eyeball-protruded/jaundice
 No Pupils-presence of cataracts
 Eyebrows- distribution is normal
 Conjunctiva –color is normal /no discharge
 Visual acuity-normal
Nose
 Is Symmetry
 No discharge
 No polyps
 sense of smell is present
Mouth
Lips
 size normal
 shape round
 no cracked
 no dryness
 no cleft lip / palate
Mucus membranes
 no Lesions /bleeding/
 Gingival/gums –color pale red /bleeding present
Teeth
 color –yellow –poor hygiene

 Number of teeth 32
 Distribution is disorganised
Tongue
 Size normal
 Shape normal
 Color pink
 Range of motion normal range in all direction
 No Lesions
No Tonsils –swelling
Sense of testing present
EAR
 Size normal
  shape normal
 no discharge
 no wounds
 sense of hearing present
 Neck
 no Scars / lesion.
 Range of motion –normal
 No Palpate for swollen lymph node /tonsils

 Chest
 Is Symmetry
 Lung sound is clear no wheezing or crackles
 Heart sounds s1 and s2 is audible
 Size normal
 Shape normal

 Abdomen
 Size normal
 Shape long
 Skin –color black
 No Striae /linear nigra
 No Organomegaly
 Bowel movement (peristalsis) is present
 No Edema
 No Swelling
 No Pains
 Scar present
 No Wound
 Back
 Shape normal
 Is Symmetry
 No Deformities
- Scoliosis
- Lordosis
- Kyphosis
 No Wound
 No Lesions
 No Spinal bifida
 Scars present Extremities
Upper
 No fracture
 No Wound
 Shape normal
 Size normal
 Range of motion –normal
  Hands –palm – color normal
 Fingers
- No clubbing
- capillary refilling is less than 2sec
- no extra fingers
Lower
 no fracture
 Wound present on thighs and buttocks.
 Shape normal
 Size is small
 Range of motion –abnormal
 No Skin-varicose vein
 No Edema
 feet – sole present
- color black
- cracks is present
- no club foot
- no Valgus
 toes
- no clubbing
- capillary refilling normal
- no presence of jiggers
- athlete foot present

 Perineum
 No Discharge –color /smell
 Presence of hair /distribution /color /texture is normal
 Penis
- Size normal
- No Hypospadiasis
- No Epispadiasis
- Is Circumcised
- No Discharge-color /smell
- No Pain on retracting the prepuce
- No Wounds

Anus

- Wound present
 - No Hemorrhoids
- No Prolapsed
- No Cracks
- No Lesions

SYSTEMIC ASSESSMENT

- Neurological: the patient is conscious , the Glasgow coma scale is 15/15

 Level of consciousness is alert
- Respiratory
 Lung sounds are present and clear
 Respiration: no bradycardia or tachypnea
- Digestive : no dental carries
-
- Abdomen issoft
- Bowel sounds are present,
- no pain
- no diarrhea
- no vomiting or nausea ,has incontinence of stool due to paralysis.
normally.
- Integumentary(skin): has wounds on the buttocks

- Urinary system :has incontinence of urine due to paraplegia. The urine

output is normal.

- Musculoskeletal : no fracture. Has muscle weakness due to paraplegia.

- Cardiovascular :heart sounds are normal. Capillary refill time is less than 2
seconds. Pulse is normal 86beats/min .blood pressure is normal 120/90.

SCHIZOPHRENIA

INTRODUCTION

Schizophrenia is a chronic and severe mental disorder that affects how a

person thinks, feels, and behaves. People with schizophrenia may seem like
they have lost touch with reality. Although schizophrenia is not as
common as other mental disorders, the symptoms can be very
disabling.

Signs and Symptoms

Symptoms of schizophrenia usually start between ages 16 and 30. In rare
cases, children have schizophrenia too.

The symptoms of schizophrenia fall into three categories: positive,

negative, and cognitive.

Positive symptoms: “Positive” symptoms are psychotic behaviors not

generally seen in healthy people. People with positive symptoms may “lose
touch” with some aspects of reality. Symptoms include:

Hallucinations,Delusions,Thought disorders (unusual or dysfunctional

ways of thinking),Movement disorders (agitated body movements)

Negative symptoms: “Negative” symptoms are associated with disruptions

to normal emotions and behaviors. Symptoms include:

“Flat affect” (reduced expression of emotions via facial expression or voice

tone),Reduced feelings of pleasure in everyday life,Difficulty beginning
and sustaining activities,Reduced speaking

Cognitive symptoms: For some patients, the cognitive symptoms of

schizophrenia are subtle, but for others, they are more severe and patients
may notice changes in their memory or other aspects of thinking.
Symptoms include:

Poor “executive functioning” (the ability to understand information and use

it to make decisions)

Trouble focusing or paying attention

Problems with “working memory” (the ability to use information

immediately after learning it)

Risk Factors

There are several factors that contribute to the risk of developing

schizophrenia.

Genes and environment: Scientists have long known that schizophrenia

sometimes runs in families. However, there are many people who have
schizophrenia who don’t have a family member with the disorder and
conversely, many people with one or more family members with the
disorder who do not develop it themselves.

Scientists believe that many different genes may increase the risk of
schizophrenia, but that no single gene causes the disorder by itself. It is not
yet possible to use genetic information to predict who will develop
schizophrenia.

Scientists also think that interactions between genes and aspects of the
individual’s environment are necessary for schizophrenia to develop.
Environmental factors may involve:

Exposure to viruses

Malnutrition before birth

Problems during birth

Psychosocial factors

Different brain chemistry and structure: Scientists think that an

imbalance in the complex, interrelated chemical reactions of the brain
involving the neurotransmitters (substances that brain cells use to
communicate with each other) dopamine and glutamate, and possibly
others, plays a role in schizophrenia.

Some experts also think problems during brain development before birth
may lead to faulty connections. The brain also undergoes major changes
during puberty, and these changes could trigger psychotic symptoms in
people who are vulnerable due to genetics or brain differences.

Treatments and Therapies

Because the causes of schizophrenia are still unknown, treatments focus

on eliminating the symptoms of the disease. Treatments include:

Antipsychotics

Antipsychotic medications are usually taken daily in pill or liquid form.

Some antipsychotics are injections that are given once or twice a month.
Some people have side effects when they start taking medications, but
most side effects go away after a few days. Doctors and patients can work
together to find the best medication or medication combination, and the
right dose. Check the U.S. Food and Drug Administration (FDA) websitefor
the latest information on warnings, patient medication guides, or newly
approved medications.

Psychosocial Treatments
These treatments are helpful after patients and their doctor find a
medication that works. Learning and using coping skills to address the
everyday challenges of schizophrenia helps people to pursue their life
goals, such as attending school or work. Individuals who participate in
regular psychosocial treatment are less likely to have relapses or be
hospitalized. For more information on psychosocial treatments, see
the Psychotherapies webpage on the NIMH website.

Coordinated specialty care (CSC)

This treatment model integrates medication, psychosocial therapies, case

management, family involvement, and supported education and
employment services, all aimed at reducing symptoms and improving
quality of life. The NIMH Recovery After an Initial Schizophrenia
Episode (RAISE) research project seeks to fundamentally change the
trajectory and prognosis of schizophrenia through coordinated specialty
care treatment in the earliest stages of the disorder. RAISE is designed to
reduce the likelihood of long-term disability that people with
schizophrenia often experience and help them lead productive,
independent lives.

How can I help someone I know with schizophrenia?

Caring for and supporting a loved one with schizophrenia can be hard. It
can be difficult to know how to respond to someone who makes strange
or clearly false statements. It is important to understand that
schizophrenia is a biological illness.

Clinical manifestation

Management

Medical management

SNO NAME OF ACTION SIDE ANTIDOTE REMARKS

MEDICATION EFFECTS
1 Tegretol Indicated for the Ataxia (15%) No specific Is not used for
 treatment of Dizziness antidote hypersensitivity
partial seizures (44%) to cloxacillin
with complex Drowsiness other
symptomatology (32%) penicillins
(eg, Nausea (29%) ,cephalosporins
psychomotor, Vomiting ( or any
temporal lobe), component of
the formulation
generalized
tonic-clonic
seizures (grand
mal), and mixed
seizure patterns,
which include
the seizure
types listed here
or other partial
or generalized
seizures

MANAGEMENTS

he main types of treatment are counseling and medicines to lessen or stop

psychotic symptoms. Medicines will control psychotic symptoms in most people.
In milder cases of schizophrenia, medications may not be needed. Medicines can:

Lessen or stop hallucinations,Help the person tell the difference between

hallucinations and the real world,Lessen or stop false beliefs,Lessen feelings of
confusion.Help the person think more clearly

Lessening of these symptoms can help the person resume his or her normal
lifestyle and activities. Medicines for schizophrenia need to be taken regularly,
even after symptoms are gone. Some people with schizophrenia will stop taking
their medicine because they believe the medicine is no longer needed, or they
dislike the medication's side effects. Psychotic symptoms often return when
medication is stopped. Do not stop taking medicine without the advice of your
healthcare provider.

Nursing management
 Encouraging good health maintenance activities
 Providing proper nutrition
 Providing a rigorous skin care program ranging from proper positioning to
correct body alignment
 Establishing and following bowel and bladder programs.
  Maintaining mobility and range of motion
 Keeping a clean safe environment
 Encouraging client to be independent
 Monitoring of vital signs
 Proper wounds dressing using appropriate solution in case of bedsores
 Prevention of further development of bedsores
 Patient and family reassurance and counseling.
 Help the patient to found the activity that he must do to prevent to be
useless in the family.

NURSING MANAGEMENT

I. List of patient problem

1. Low self-esteem

2. Fear r/t phobic stimulus

3. Disturbed thought processes

II.Priority

1. Low self-esteem

2. Fear r/t phobic stimulus

XV. NURSING CARE PLAN

ASSESSMENT NURSING GOALS INTERVENTION RATIONALE EVALUATION
DIAGNOSI
S

Subjective data Low self- Short term Ask what client These Shows respect and After nursing
She says” it is better esteem After five would like to be acknowledge the person. intervention,
to die, I do not know related to days of called. The manner in which one patient
why am still alive let changes in interventio Assess degree to is treated by others may improving and
me die”
Objective data
health status n ,she will which patient feels influence her self-esteem. show a
She has low self-esteem as identify loved and respect by Helps the client to adapt confidence
with negative insight, evidenced one or two others. to change, and reduces some. Continue
has also logorrhea and by negative strengths Encourage anxiety about altered monitoring a
agitation to her mother feedback owned verbalization of function/lifestyle patient and
who brought to
hospital.
about self feelings, accepting Promotes feelings of giving a
through Long term what is said. safety, encouraging prescribed drugs.
client’s After three Provide non- verbalization
status like weeks of threatening
Vital signs being interventio environment, listen Age is an indicator of the
BP=119/78 mmHg
Pls= 72 BpM
worthless n the client and accept client as stage of life patient is
T0=37.2 0C will presented. experiencing, e.g.,
RR=18 BpM identify the Identify age and adolescence, middle age.
skills and developmental level Clarification and
positive verification of what has
aspect that Reflect back to client been heard promotes
are owned what has been said understanding and allows
by the client to validate
patient information, otherwise
assumptions may be
inaccurate.
Acknowledge efforts Provides encouragement
at problem solving and reinforces
and future planning. continuation of desired
behaviors.
Conveys confidence in
Determine client client’s ability to cope.
awareness of own When client acknowledges
responsibility for own part in planning and
dealing with situation carrying out treatment plan,
he has more investment in
following through on
decisions that have been
made.
Assessment Nursing Objectives Planning Rationale Evaluation
diagnosis
S:“Whenever I’m Fear r/t phobic After 3 hours 1 . Establish rap ➢ To gain client’s After 3 hou
surrounded with stimulus as of nursing port cooperation interventio
too many people manifested by intervention the 2 . Discuss to acknowl
either I know Diminished client will client’s ➢ Promote and recogn
them or not I still activity, acknowledge and perception/fearf atmosphere of unhealthy f
feel scared and Avoidance, and discuss fears, ul feelings. caring and permits 1.Stated5/5
restless” as Narrowed focus recognizing Listen to explanation/correc 2.Summari
verbalized by the on the source healthy versus client’s concern tion discussion
patient of fear unhealthy fears as of misperception to lack of t
manifested by 3. ➢ Facilitates
Objective data: State at least 3/5 Provideinforma
understanding and
•Diminished example of fears tionin verbal
retention
activity Understanding and written
of information
•Avoidance of what have form. Speak in
➢ Enhances sense
•Narrowed focus discussed by simplest
of trust and nurse-
on the source of summarization sentences.
client relationship
fear 4 . Provideoppo
rtunity for
questions and
answer honestly

Health education

The patient is educated on the following:

Prevention of pressure sores: patient is educated on prevention and monitoring
techniques of bedsores. The patient is encouraged to take care of his skin, change
clothes and garnitures in cases of unexpected leaks. When the redness of the skin
occurs the patient and his relative are educated on the importance of eliminating
all pressure on the affected area until the redness disappears or fades significantly.

The patient and relative are educated on how to get out of the bed and the proper
use of a wheelchair.

The patient is also educated on the importance of balanced diet rich in fibers and
large amount of liquids to help the intestinal transit as well as regular abdominal
massages 15minutes prior to having a bowel movement.

The patient is also educated on the importance of doing same motions of joints
located in the affected areas to prevent muscle shortening caused by contractures
and reinforces non-paralyzed muscles.

Reference: www.spinal-injury .net.

https://www.drugs.com/ppa/cloxacillin.htm

https://en.m.wikipedia.org/wiki/paralysis

www.health line.com/health/paralysis